Treatment of Temporomandibular Joint Disorder (TMJD)

First-Line Conservative Approaches

The American College of Physicians recommends jaw exercises and stretching as they provide significant pain relief and functional improvement, approximately 1.5 times the minimally important difference in pain reduction 1
Manual trigger point therapy is strongly recommended as it provides one of the largest reductions in pain severity, approaching twice the minimally important difference 1, 2
Patient education about avoiding aggravating activities, maintaining a soft diet, and applying heat/cold therapy reduces pain and inflammation 1, 3
NSAIDs are recommended as first-line medications for pain relief and inflammation reduction 1
Cognitive behavioral therapy (CBT), with or without biofeedback or relaxation techniques, provides substantial pain reduction for patients with psychological factors 1, 2

Manipulation techniques for joint realignment may benefit patients who don't respond to first-line treatments 1, 2
Acupuncture shows moderate evidence of effectiveness for TMJ pain relief 1
Occlusal splints (oral appliances) may be beneficial specifically for patients with bruxism, though evidence for their general use is limited 1

Intra-articular lavage (arthrocentesis) without steroid may provide symptomatic relief in refractory cases 1, 2
Intra-articular glucocorticoid injections may be indicated for refractory and symptomatic TMJ dysfunction in skeletally mature patients, but are not recommended as first-line management 4, 1
For juvenile patients with TMJ arthritis, intraarticular glucocorticoid injections are not recommended as first-line treatment and should be used cautiously only in refractory cases 5, 4

For juvenile patients with TMJ arthritis, systemic treatment should be considered for active TMJ arthritis 7, 5
Conventional synthetic DMARDs are strongly recommended for inadequate response to or intolerance of NSAIDs and/or intraarticular glucocorticoids in juvenile patients 5, 4
Biologic DMARDs are conditionally recommended for inadequate response to or intolerance of NSAIDs and/or intraarticular glucocorticoids and at least one conventional synthetic DMARD in juvenile patients 5, 4